Tuberculosis treatment in complex emergencies: are risks outweighing benefits?


Biot, M; Chandramohan, D; Porter, JDH; (2003) Tuberculosis treatment in complex emergencies: are risks outweighing benefits? Tropical medicine & international health, 8 (3). pp. 211-218. ISSN 1360-2276 DOI: https://doi.org/10.1046/j.1365-3156.2003.01025.x

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Abstract

Tuberculosis (TB) is a major public health problem in complex emergencies. Humanitarian agencies usually postpone the decision to offer TB treatment and opportunities to treat TB patients are often missed. This paper looks at the problem of tuberculosis treatment in these emergencies and questions whether treatment guidelines could be more flexible than international recommendations. A mathematical model is used to calculate the risks and benefits of different treatment scenarios with increasing default rates. Model outcomes are compared to a situation without treatment. An economic analysis further discusses the findings in a trade-off between the extra costs of treating relapses and failures and the savings in future treatment costs. In complex emergencies, if a TB programme could offer 4-month treatment for 75% of its patients, it could still be considered beneficial in terms of public health. In addition, the proportion of patients following at least 4 months of treatment can be used as an indicator to help evaluate the public health harm and benefit of the TB programme.

Item Type: Article
Keywords: tuberculosis, complex emergencies, compliance rate, early, treatment result, modelling, drug resistance, economic analysis, Resistant mycobacterium-tuberculosis, pulmonary tuberculosis, chemotherapy, origin, Antitubercular Agents, therapeutic use, Drug Resistance, Bacterial, Emergencies, Health Care Costs, Human, Models, Theoretical, Patient Compliance, Program Evaluation, Public Health, economics, Relief Work, economics, Risk Assessment, methods, Treatment Failure, Tuberculosis, Pulmonary, drug therapy, economics, War
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Infectious and Tropical Diseases > Dept of Disease Control
PubMed ID: 12631310
Web of Science ID: 181485500005
URI: http://researchonline.lshtm.ac.uk/id/eprint/16875

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